Eur J Nucl Med Mol Imaging:心肌灌注显像可预测高心血管风险的无症状糖尿病患者的预后

2021-04-22 MedSci原创 MedSci原创

5年的随访期内,MPS对具有高心血管风险的无症状糖尿病患者可能具有预后价值。

巴塞尔无症状高危糖尿病患者结果试验(BARDOT)表明,在2年的随访中,具有异常心肌灌注显像(MPS)的无症状糖尿病患者发生重大不良血管事件(MACE)的风险增加。尚不清楚该发现是否适用于更长的随访时间。相比之下,尽管心血管风险高,正常的MPS可以识别出发生MACEs可能性极低(2.9%)的亚群。虽然一些传统的心血管危险因素可以预测MPS异常,但即使是MPS正常的高危患者,其预后也良好,无需进行有创评估或治疗。这些发现提示筛查高危糖尿病患者的无症状心肌缺血可能是有用的。到目前为止,筛查所有无症状糖尿病患者仍存在争议。在荟萃分析包括3299例无症状糖尿病与无创成像显示筛选CAD没有显著降低非致死性心肌梗死(MI)和因心力衰竭(HF)住院等事件的发生率, MPS异常患者的心因性死亡率和血运重建率较高。

在短期随访中,相对较低的MACEs发生率可能是CAD的无创评估在筛查无症状糖尿病患者方面有争议的好处的主要原因。因此,需要更长期观察的证据进行评估。Matthias Pfisterer & Michael J. Zellweger等对无症状糖尿病患者进行5年随访,探讨MPS对预后的价值,评估综合治疗方法对这些患者的影响。研究成果发表在Eur J Nucl Med Mol Imaging 杂志。

BARDOT多中心试验中,纳入400例无症状的心血管风险高的糖尿病患者,进行心肌灌注SPECT (MPS)MPS异常患者被随机分配到最佳抗缺血药物治疗或同样强烈的抗缺血管理,包括血运重建。随访5年。MPS基线正常的患者总死亡率低于基线异常的患者。异常MPS患者接受强烈的抗缺血管理,包括血运重建,有最有利的结果

临床和MPS评估了400名既无既往史也无冠状动脉疾病(CAD)症状的II型糖尿病患者。对患者进行了5年的随访。主要的不良心血管事件(MACE)定义为全因死亡、心肌梗塞或晚期冠脉血运重建。

MPS正常和异常患者每年的死亡率、每5年的总死亡率、每年平均死亡率。

基线时,在400名患者中有87名(22%)发现MPS异常(SSS≥4或SDS≥2)。5年内发生MACE的患者中14例MPS异常(16.1%)和22例扫描正常(1.7%),p  = 0.009;记录了15人死亡。MPS完全正常的患者(SSS和SDS = 0)的MACE发生率低于扫描异常的患者(2.5%比7.0%,p  = 0.032)。与仅接受药物治疗或无法进行血运重建的MPS异常患者相比,进行血运重建的MPS异常患者的死亡率更低,且MI和血运重建的无事件生存期更好(p  = 0.002)。

综上所述,5年的随访期内,MPS对具有高心血管风险的无症状糖尿病患者可能具有预后价值。MPS完全正常的患者事件发生率较低,并且可能不需要在5年内重新测试。MPS异常的患者事件发生率更高,可能会受益于医疗和血运重建相结合的方法。

原文出处

Caobelli, F., Haaf, P., Haenny, G. et al. Prognostic value of myocardial perfusion scintigraphy in asymptomatic patients with diabetes mellitus at high cardiovascular risk: 5-year follow-up of the prospective multicenter BARDOT trial. Eur J Nucl Med Mol Imaging (2021). https://doi.org/10.1007/s00259-021-05349-5

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【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/240d3ae7a8e8452d9f49793c3923ad60/78defa70ab2947c28066b378f1117648.jpg, createdBy=fa315475285, createdName=梅斯小助手, createdTime=Fri Apr 23 09:46:59 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959612, encodeId=dd7e959612e7, content=心肌灌注显像具有重要意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Thu Apr 22 23:18:14 CST 2021, time=2021-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043579, encodeId=429a10435e9c2, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Thu Apr 22 19:21:51 CST 2021, time=2021-04-22, status=1, ipAttribution=)]
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【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/240d3ae7a8e8452d9f49793c3923ad60/78defa70ab2947c28066b378f1117648.jpg, createdBy=fa315475285, createdName=梅斯小助手, createdTime=Fri Apr 23 09:46:59 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959612, encodeId=dd7e959612e7, content=心肌灌注显像具有重要意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Thu Apr 22 23:18:14 CST 2021, time=2021-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043579, encodeId=429a10435e9c2, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Thu Apr 22 19:21:51 CST 2021, time=2021-04-22, status=1, ipAttribution=)]
  5. 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  6. 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【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/240d3ae7a8e8452d9f49793c3923ad60/78defa70ab2947c28066b378f1117648.jpg, createdBy=fa315475285, createdName=梅斯小助手, createdTime=Fri Apr 23 09:46:59 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959612, encodeId=dd7e959612e7, content=心肌灌注显像具有重要意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Thu Apr 22 23:18:14 CST 2021, time=2021-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043579, encodeId=429a10435e9c2, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Thu Apr 22 19:21:51 CST 2021, time=2021-04-22, status=1, ipAttribution=)]
  7. 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【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/240d3ae7a8e8452d9f49793c3923ad60/78defa70ab2947c28066b378f1117648.jpg, createdBy=fa315475285, createdName=梅斯小助手, createdTime=Fri Apr 23 09:46:59 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959612, encodeId=dd7e959612e7, content=心肌灌注显像具有重要意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Thu Apr 22 23:18:14 CST 2021, time=2021-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043579, encodeId=429a10435e9c2, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Thu Apr 22 19:21:51 CST 2021, time=2021-04-22, status=1, ipAttribution=)]
    2021-04-23 科研科研科研

    MPS患者

    0

  8. 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【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/240d3ae7a8e8452d9f49793c3923ad60/78defa70ab2947c28066b378f1117648.jpg, createdBy=fa315475285, createdName=梅斯小助手, createdTime=Fri Apr 23 09:46:59 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959612, encodeId=dd7e959612e7, content=心肌灌注显像具有重要意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Thu Apr 22 23:18:14 CST 2021, time=2021-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043579, encodeId=429a10435e9c2, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Thu Apr 22 19:21:51 CST 2021, time=2021-04-22, status=1, ipAttribution=)]
    2021-04-23 梅斯小助手

    三人行,必有我师。 #梅斯医学科研互助群# 欢迎您的加入,添加【梅斯医学科研助手WeChat:medsci_2021】邀您进群! 【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!

    0

  9. 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【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/240d3ae7a8e8452d9f49793c3923ad60/78defa70ab2947c28066b378f1117648.jpg, createdBy=fa315475285, createdName=梅斯小助手, createdTime=Fri Apr 23 09:46:59 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959612, encodeId=dd7e959612e7, content=心肌灌注显像具有重要意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Thu Apr 22 23:18:14 CST 2021, time=2021-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043579, encodeId=429a10435e9c2, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Thu Apr 22 19:21:51 CST 2021, time=2021-04-22, status=1, ipAttribution=)]
    2021-04-22 Doctoryangbai

    心肌灌注显像具有重要意义

    0

  10. 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【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/240d3ae7a8e8452d9f49793c3923ad60/78defa70ab2947c28066b378f1117648.jpg, createdBy=fa315475285, createdName=梅斯小助手, createdTime=Fri Apr 23 09:46:59 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959612, encodeId=dd7e959612e7, content=心肌灌注显像具有重要意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Thu Apr 22 23:18:14 CST 2021, time=2021-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043579, encodeId=429a10435e9c2, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Thu Apr 22 19:21:51 CST 2021, time=2021-04-22, status=1, ipAttribution=)]
    2021-04-22 misszhang

    谢谢MedSci提供最新的资讯

    0

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Dig Liver Dis:不受控制的糖尿病会增加晚期肝硬化患者的感染的风险

全球糖尿病(DM)的发病率呈现出一个加速上升的趋势,并且对于肝脏疾病的影响也越来越明显。有研究显示糖尿病与肝硬化、肝细胞癌和非酒精性脂肪肝疾病的发生都独立相关。

Am J Clin Nutr: 坚果摄入和2型糖尿病发病风险之间的关系

坚果是营养非常丰富的食物,具有大量复杂的微量营养素,钠含量低而富含不饱和脂肪酸,膳食纤维,镁,植物蛋白,其中一些可能产生广泛的健康益处。

Lancet Diabetes Endo:降糖药物处方对糖尿病患者新冠肺炎死亡风险的影响

部分降糖药物可降低糖尿病患者感染新冠肺炎后死亡风险,但风险差异很小,不能排除混淆风险。不建议糖尿病患者因新冠肺炎因素改变降糖药物处方

JAHA:二甲双胍与磺脲类药物治疗的伴有肾功能下降的糖尿病患者心衰住院比较

在肾功能恶化的2型糖尿病患者中,与磺脲类药物相比,持续使用二甲双胍可降低心衰住院率。

以创新续写胰岛素百年传奇,赛诺菲助力糖尿病患者摆脱“甜蜜负担”

2021年4月10日,赛诺菲胰岛素百年峰会以线上线下联动的方式在全国12个城市同步举办。50余位来自国内外内分泌领域的临床专家、逾33000名全国各地的医院的医生以及赛诺菲企业高管参与了活动,共同庆祝